By Cynthia McMurry, KF8 Ecuador
Time and cost are enormous disincentives for the working poor when it comes to getting medical treatment. Time spent visiting the doctor is time you’re not at work generating income, and money spent on these visits is money that could otherwise be spent on your children’s education or reinvested in your business. These disincentives are strong enough that relatively minor, treatable ailments often go untreated and eventually develop into much more complicated, serious conditions that require more intensive treatments and can even be incapacitating.
To mitigate this problem, medical care must be made cheaper and more convenient, and this is exactly what’s being done at the Cuenca branch office of Fundación Espoir. The office has an on-site doctor’s office. Each client pays $4.50 per 6-month loan cycle, for which she is entitled to unlimited free doctor’s visits for herself, her husband and her children. Women can get Pap tests, pre- and post-natal care and birth control counseling, in addition to a wide variety of treatments for common ailments. The clinic, which is always staffed by one of two doctors, serves 250-280 women and their family members each month. Dr. Maria Eulalia Robles says that most clients, whether women, men or children, come in for three reasons: dermatological problems, respiratory ailments, and diarrhea. Treatment is key, especially for children: left untreated, respiratory ailments and diarrheal diseases are responsible for almost 40% of mortality in Ecuadorian children ages 1-4 (as of 1999).
The clinic is understandably limited in terms of the services it can provide, since there’s no on-site laboratory or sophisticated machinery for taking x-rays or performing mammograms. For more specialized services like these, Espoir’s doctors refer clients to low-cost local specialists like gynecologists, optometrists, dentists, and chiropractors. One of branch manager Eulogio Rojas’ goals is to acquire a mammography machine for the clinic, though he says that at the moment he can’t justify the cost of such a machine ($40,000+) for the less than 2,000 clients the office serves.
Dr. Robles says that more than half the clients she sees come in before or after their group meetings at Espoir’s office. In a sense, this is a good thing, since it means that clients will seek medical care when it’s made more convenient for them. It’s also troubling, though, since about half the clients served by the Cuenca branch office hold their meetings in the field, closer to home. Rural clients visit the clinic much less frequently because of the opportunity cost implicit in each trip to the city.
Another challenge she faces is cultural. Getting an annual Pap test is a foreign concept for most clients, and for many it goes beyond being merely uncomfortable. Dr. Robles says some clients consider the test on par with rape. Many women’s husbands are against the idea, so the small percentage of clients who do come in for Pap tests often do so secretly.
Both Dr. Robles and Eulogio Rojas hope that the clinic will offer a wider range of services in the future; the office has already shown impressive progress and growth over its short life. The clinic opened six years ago, and in its first years treated a maximum of 90 clients per month. Today, it sometimes treats that many patients in one week. The clinic has also had electronic medical records for all patients for the past three years (which is more than many clinics in the US can say!).
Dr. Robles tells me of a patient she treated just a couple of weeks ago. The client, a 36-year-old, overweight woman with hypertension, came in for a basic gynecological exam, in which the doctor found a uterine polyp that could develop into cancer if left untreated. She referred the client to a gynecologist, who found that the patient had incipient uterine cancer and operated immediately to remove the polyp. The operation appears to have been successful! If this young mother hadn’t had convenient, low-cost access to medical care, this close call might have turned into a tragic ending.
The innovative medical care facility offered by Fundación Espoir is one of a whole slew of reasons why I’m excited to help them get started as a brand new Kiva field partner (and its only active Ecuadorian partner)! In my first two weeks working with the institution, I’ve been consistently impressed by its staff’s dedication to improving clients’ lives through savings accounts, loans, and business training and health education services. Eulogio Rojas sees Espoir’s partnership with Kiva as a great opportunity to get to know his own clients a little better, an attitude I applaud. Personally, I can’t wait for Kiva lenders to get to know Espoir’s clients!
Cynthia McMurry is a fourth-time Kiva fellow working with brand new Kiva field partner Fundación Espoir in Cuenca, Ecuador. Previously she worked with Fundación AgroCapital in Bolivia and FINCA Peru and Asociación Arariwa in Peru./>